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| Coronavirus by TP Heinz via Pixabay |
As I write, the coronavirus pandemic which began as a mysterious respiratory illness in Wuhan City of China late last year has now engulfed the whole world with more than 1.4 million infected and more than 82000 deaths. The disease is officially known as COVID-19 ( coronavirus disease 2019 ) and the virus responsible for the illness is the SARS-CoV-2 ( Severe Acute Respiratory Syndrome Coronavirus 2 ).
Symptoms of the infection can range from asymptomatic to being a flu-like illness with malaise, fever, cough and dry throat, to severe respiratory distress requiring critical care. Being a viral illness meant that there is no effective treatment against it and it is largely left to the immune system to deal with the infection. Any medical intervention is therefore limited to providing life support and preventing further spread of the contagion.
Since the virus spread by means of droplets and surface contact, conditions of crowding and close person-to-person contact would facilitate its transmission. It was therefore not surprising that in Jan 2020 the Diamond Princess, a cruise ship which carried a total of 3711 passengers and crew, became a hotbed for COVID-19 transmission. It was quarantined at the Japanese port city of Yokohama since early February but because of poor, inadequate and perhaps ineffective infection control onboard, the total number of confirmed cases of COVID-19 eventually reached 712 with 567 passengers and 145 crew members infected. 12 had died.
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| The crowded pilot house of the Gerald R Ford ( CVN-78 ) during replenishment-at-sea. It is impossible to achieve any meaningful physical distancing when working and living onboard a ship. USN Photo |
Now the living conditions onboard a warship is not much different from those onboard a commercial vessel. Space is always a premium on a ship. Confining a large group of people to a small area for an extended duration is the prime recipe for a highly contagious disease to spread. During a pandemic, all ships, merchantman or man-of-war, are simply floating incubators, epidemiological time bombs waiting to explode. With the news that the nuclear-powered attack carrier USS Theodore Roosevelt ( CVN-71 ) has been ravaged by the coronavirus and is now anything but war capable, we know that even the world's mightiest navy is not immune to this health menace. Is there anything that can be done to minimize the risk of a COVID-19 outbreak onboard a warship? Of course there are, but it would mean many of our traditional habits and the way we conduct our businesses and carry out our missions would have to be modified or changed drastically. Perhaps every future ship design would have to include special areas for medical treatment and isolation and even berthing arrangements and living quarters have to be redesigned.
As a case study we can look to the USS Theodore Roosevelt to appreciate what a tiny virus can do to a large warship in a matter of days.
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| The USS Theodore Roosevelt at the South China Sea with the America Expeditionary Strike Group 15th Mar 2020. USN Photo. |
The Grounding Of A Carrier
The Roosevelt Carrier Strike Group ( CSG ) comprising of the aircraft carrier USS Theodore Roosevelt and its surface and submarine escorts including the guided missile cruiser USS Bunker Hill ( CG-52 ) and several destroyers departed San Diego on 17th Jan 2020 for its Indo-Pacific deployment.
The CSG arrived at Apra Harbor, Guam, on 6th Feb after sailing across the Pacific Ocean. We can assume the sailors were granted their well deserved shore leave on Guam and they had also participated in various community relations activities over that weekend, such as interacting with young kids from a school, clearing and cleaning up a trail in a nature park, repainting of a veteran's memorial, and some other miscellaneous repairing and rebuilding projects.
It then sailed westwards and arrived at Da Nang on 5th Mar to commemorate the 25th anniversary of the normalization of US-Vietnam diplomatic relations, becoming the second US aircraft carrier to make a port call in Vietnam since the fall of Saigon in 1975. As it was a high profile visit, the CSG was met by a whole host of Vietnamese and US government and military officials including Adm. John C. Aquilino, commander of the U.S. Pacific Fleet, and U.S. Ambassador to Vietnam Daniel Kritenbrink. Needless to say, there were also plenty of functions and receptions for the senior ranks to attend both ashore on onboard ship. For the lower ranks, the usual community relations projects were unavoidable. Somehow the military just love these social out reach programs and they can never have enough of them.
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| Reception at Da Nang 5th Mar 2020 : Ambassador Daniel Kritenbrink with COMPACFLT Adm John Aquilino (R), COMCARSTRKGRU9 RAdm Stuart Baker (L) and Capt Brett Crozier ( extreme L ). USN Photo. |
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| Roosevelt ship crew dancing with locals at Dorothea's Project Legacies Charity Center Da Nang 6th Mar 2020. USN Photo. |
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| Military dignitaries from the Socialist Republic of Vietnam visited the carrier on 7th Mar 2020. USN Photo. |
After Da Nang, on 15th Mar the CSG deployed to the South China Sea and sailed with the America Expeditionary Strike Group and the 31st Marine Expeditionary Unit as a combined Expeditionary Strike Force. On 18th Mar the CSG even managed some joint exercise with aircrafts like the F-15C from the US Pacific Air Forces operating out of Kadena AFB in Okinawa with a B-52H thrown in.
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| Exercising with the Air Force in the Philippine Sea 18th Mar 2020. USN Photo. |
By 24th Mar however, the first cases of coronavirus infection has been reported among 3 ship crew onboard the Teddy Roosevelt. The number of the infected increased to 8 just a day later. Most of the infected only showed mild symptoms but they were flown off the aircraft carrier to the US Naval Hospital Guam for further tests, evaluation and quarantine. To fight the worsening outbreak, the US Navy had by then ordered the diversion of the carrier back to Guam and to have all of her 4845 sailors and airmen tested for the coronavirus. Acting Secretary of the Navy Thomas Modly insisted that the carrier was still fully operational despite the disease outbreak but we known otherwise. How can a carrier be combat ready when it is tied at pier-side?
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| Captain Brett Elliott Crozier, USN. CO USS Theodore Roosevelt. Photo : Wikipedia |
Unfortunately for the Teddy Roosevelt, the number of infected sailors just kept increasing exponentially. By the time the carrier docked at Guam on 27th Mar the figure had risen to 25 infected. Soon after it became 36, and then 70. Worried about the health and safety of the sailors and airmen onboard the carrier, the commanding officer Captain Brett Crozier wrote a memo to the naval high command pleading for help to contain the outbreak, specifically to authorize the removal of about 4000 ship crew to a land based facility for two weeks of quarantine while a skeletal crew remain shipboard to run and maintain critical systems and deep clean the ship. The problem was Guam being an island in the middle of the Pacific Ocean did not have means to quarantine 4000 people on land. The captain's memo was somehow leaked to the San Francisco Chronicle and before anyone knew, the entire world had learnt about the Roosevelt's predicament.
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| Aerial view of Apra Harbor, Guam with USS America (LHA-6) at pier side 21 Mar 2020. USN Photo. |
As a result of his plea and the publicity it generated, arrangements have been made to transfer about three thousand sailors ashore for quarantine. Not all could be evacuated as a skeletal crew had to remain onboard to operate critical systems that could not be shut down, like the Roosevelt's two Westinghouse A4W pressurized water nuclear reactors. Security and fire fighting details and a few hundred ship crew will have to remain onboard to deep clean the carrier which was estimated to take about 10 days. One thousand had left the ship on 1st Apr, with more to follow. It generated a lot of unhappiness among the local population of Guam who were rightly afraid that the sailors would introduce the coronavirus to their island.
So far all the infected personnel are medically stable and do not require hospitalization, ventilator support or critical care. Nobody from the Roosevelt has yet died from the infection but the captain's actions would eventually cost him his job. On 2nd Apr Acting Secretary of the Navy Thomas Modly relieved Capt Brett Crozier of his command citing loss of confidence and lack of leadership in times of crisis. He left his ship amidst a rousing send off by the ship crew, who clearly believed that their commanding officer had acted with their safety and well being at heart. By then the number of infected had already reached 114.
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| Seabees from the 1st and 5th Naval Mobile Construction Battalion with vehicles to transport sailors to shore based quarantine facilities 3rd Apr 2020. USN Photo. |
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| COMSEVENTHFLT Vice Admiral Bill Merz visits barracks housing quarantined sailors at Guam 5th Apr 2020. USN Photo. |
By 5th Apr Defense Secretary Mark Esper told CNN there were 155 infected. Even the poor captain himself had come down with the infection and is currently in quarantine. He had shown symptoms before he left his command.
The latest twist of this saga was that Thomas Modly himself was forced to resign as the acting secretary of the Navy on 7th April, a day after he described Capt Crozier as " too naïve or too stupid " to be in command, in a speech given during his visit to the aircraft carrier. The abrupt manner of Capt Crozier's dismissal as the commanding officer without going through a board of inquiry and due process was also a sticking point among naval personnel. The latest infected numbers on 7th Apr stood at 230 and it will surely go up in the coming weeks.*
As anyone could see, in about slightly more than a week, there were more than two hundred personnel who contracted the virus and the aircraft carrier is effectively non-operational being confined to port with more than half its compliment disembarked and on quarantine. We might never know how the virus first infected the ship, but a common assumption was from the 5 day port visit to Da Nang ( 5th - 9th Mar ). With the bulk of its crew now in quarantine, I suspect the Roosevelt's COVID-19 cases will peak in two weeks though new cases will continue to emerge sporadically for several more weeks since not all ship crew could be quarantined at the same time.
The good news is that since most of the ship's compliment are young and presumably healthy, most of Roosevelt's COVID-19 cases should recover with hopefully minimal complications. And once these people recover, they should have immunity against the coronavirus and they can even be deployed to provide care for their COVID-19 stricken compatriots without the need for those cumbersome personal protective equipment! They can also be a reliable donor source for the promising but not yet FDA-approved convalescent plasma therapy where the neutralizing antibodies against the coronavirus present in the plasma of recovered patients is transfused to help the acutely infected recover. In the unlikely event that a huge proportion of the ship crew eventually acquires the infection and the herd immunity threshold ( HIT ) is reached, the rest of the uninfected members will then be protected. The problem is this coronavirus outbreak is so new that nobody really knows what its HIT is. For measles, the HIT is between 90 to 95% to achieve herd immunity. Other less contagious diseases have lower HIT.
* 10 Apr - infected ship crew now hits 416. 3170 tested negative with 1164 results still pending. One sailor in ICU.
* 11 Apr - 92% ship crew tested. 550 positive, 3673 negative. 3696 moved ashore.
* 13 Apr - 585 infected. One death.
* 15 Apr - 615 infected. Majority asymptomatic ( 350 ). Chief Petty Officer Charles Thacker identified as sailor who died.
* 23 Apr - 840 positive. 4098 negative. 4234 moved ashore. 88 recovered. Tests completed.
* 28 Apr - USN COVID-19 Update website says 940 active cases, 29 recovered. Change in reporting parameter means only those with 2 successive negative tests count as recovered.
Infection Control Measures For COVID-19
To prevent personnel from acquiring and spreading COVID-19 onboard warships especially during deployments of prolonged duration, navies have to completely change the usual way peacetime naval operations are conducted.
As COVID-19 numbers keep rising in every country which can only mean there is sustained local / community transmission of the coronavirus, it is inevitable that some military personnel would have been infected as well. Whereas the ground and air force personnel could be immediately isolated and sent home or quarantined at a designated facility when found to be infected, the same arrangements could be impossible for naval personnel during a major deployment. Here are some changes that can potentially make a difference in the prevention of contagion onboard deployed ships.
Defer Unnecessary Trainings And Deployments
Just as the general public had been told to avoid and defer all unnecessary travels, the navy should also limit their fleet deployments to those that are of absolute necessity. All training deployments should be deferred until the pandemic has run its course. All chest-thumping / show-of-force type operations like those Freedom of Navigation operations should cease immediately. Training exercises can be postponed. If it is about saving lives like search and rescue missions, medical relief missions for the pandemic, or if the sovereignty or survival of the nation is at stake, like nuclear deterrence missions, proceed with caution.
Pre-Deployment Quarantine
The incubation period ( time between exposure to the development of symptoms ) of the SARS-CoV-2 virus is said to be between 2 to 7 days with a mean ( average ) of 4 days. In some cases the incubation period can be as long as 14 days. In order to ensure all embarked ship crew are healthy and not carrying or incubating the virus, they should be put to 14 days of pre-deployment quarantine. It should preferably be done at a base facility where there are rooms with attached toilet and shower, one individual to each room. There should be daily temperature checks and the monitoring of symptoms.
Any individual who develops fever or flu-like symptoms during this 14 day isolation period will have to be thoroughly checked for COVID-19 infection. Only if the individual is well and symptom free at the end of the 14 days can he or she be allowed to embark for deployment.
Vessel Preparation For Deployment
While the ship crew are under pre-deployment quarantine, the usual routine pre-sailing ship preparation will perhaps have to be undertaken by their squadron mates. Fuel, ammunition and food supplies have to be loaded, preferably in quantities sufficient to last the entire deployment if practicable. Such stores should be sanitized prior to loading onboard ship with the appropriate method, disinfectant spray, ultraviolet light etc. Medical supplies including personal protective equipment, medications, diagnostic equipment will have to be catered for. The ship should be deep cleaned prior to the embarkation of those who passed quarantine.
Special Measures When Underway
Ship crew should refrain from group gatherings like briefings and meetings as much as possible. They should try to maintain a physical distance of at least a metre from each other if practicable. Meal times should be staggered to avoid having large groups in the mess hall. The use of recreational facilities like the gym and ward rooms should similarly be regulated to maintain physical distancing.
Since ship systems need to be manned continuously once underway, the crew would have been organized into different teams to work in shifts. Members of different teams should also refrain from mingling with each other after-shift so that in case any team member is down with an infection and the entire team has to be in quarantine, at least the other teams would not be affected.
Another important area to note is movement of personnel between different vessels of the task group should be prohibited. Similarly transfer of personnel in and out of each ship should also be limited to medical or other emergencies only.
Avoiding Unnecessary Port Calls
This will be tough as port calls are frequently the highlight of every deployment. Who does not like the opportunity to visit a foreign city and experience a different culture even if it is only for a few days? Many things happen during port calls as ships replenish their depleted food supplies and take on fuel if necessary. The host country might organize a reception ashore for the ship's company and then the ship will have to reciprocate by hosting a shipboard reception during which lots of guests and ship officers and crew will mingle and party. There is no doubt that such functions are standard naval protocol and can foster the development of bilateral ties, friendship and camaraderie. They are also potential hotbeds for COVID-19 transmission and should be banned altogether during this pandemic.
It is also a common practice for navies all over the world to conduct community relations events or community outreach programs whenever the ship docks at a foreign port. So visiting some orphanage or old folk's home, repainting a school, cleaning up a beach or a park .... becomes mandatory for the lower ranks. These activities can frequently bring real benefits to the local communities, touch lives and also hopefully benefit the participants by accentuating their sense of humility seeing and serving the less fortunate. Again, during an epidemic or pandemic, these relations building activities should cease completely. The opportunity to serve will always remain and can be engaged again after the disease outbreak is under control.
For short deployments ships should therefore be as self-sufficient as possible and avoid port calls altogether. For longer deployments, port visits should be limited to taking on and off-loading essentials and no shore leave should be granted. No visitors should be allowed onboard the ship unless of absolute necessity, like the harbor pilot to ensure safe navigation into and out of the port. Even then keep a safe physical distance and provide the pilot with a surgical mask if he is not already wearing one and remind him not to touch anything. And don't forget to clean up the bridge after he leaves.
Good Personal Hygiene
Perhaps the single most important measure against the spread of the coronavirus is the practice of good personal hygiene. An infected person will be shedding a lot of the virus through the nasal mucous and phlegm from the throat. When he or she sneezes or coughs, droplets can land on surfaces or be directly inhaled by others in close proximity. An infected person's hands will be also likely be heavily contaminated with the virus if he or she wipes the nose without subsequently washing the hands.
With the understanding of how the virus spreads, frequent hand washing with soap or the use of disinfecting hand rubs are therefore the best defense against getting infected. Keep your hands clean and try not to touch your face or rub your eyes because that's how the virus enters your body - through the eyes ( conjunctiva ), the nose or the mouth via your dirty hands.
Wash your hands before you have your meal and also after you have visited the toilet. Coronaviruses can be shed through the feces of an infected person. Sometimes viral RNA can be detected in the feces long after they have recovered from the illness, though it could be just viral genetic material and not the viable virus itself. So shared heads / communal toilets must be kept clean. Common areas should be regularly cleaned with disinfectants.
Masks
There is now sufficient evidence to suggest that pre-symptomatic spread of the coronavirus can occur. Universal mask wearing might be a good idea for all personnel onboard the ship for self protection and for protecting others should one fall sick and unknowingly spread the virus during the incubation phase. Exemptions can be made for those in anti-flash gear.
A properly made disposable surgical mask has a waterproof middle layer that prevents respiratory droplets from a sick person from escaping and infecting other people. An N95 type respirator is not necessary for non-medical use. Not only are some types of N95 mask not fluid resistant, they are also very uncomfortable to wear and may result in the wearer touching the face much more frequently to adjust the uncomfortable mask resulting in higher risk of infection.
Masks alone cannot prevent COVID-19 infection and must be used in combination with other measures for infection control. Between them, hand washing and physical distancing are still more important.
There is currently a worldwide shortage of masks, surgical as well as N95, as the pandemic rages. Most mask manufacturing countries have restricted and then banned their export altogether with the hope of keeping whatever is available for themselves. Since we are nowhere even near the peak of the pandemic, mask shortages will be the order of the day for many many months to come. Conserve your masks and save your stock for later when shit really hits the ceiling. Quartermasters and medics guard your mask supplies like gold and ration them carefully.
Unless you have an unlimited supply, do not discard your mask after a single use like what most would do before. Instead, keep the disposable mask clean and you can reuse it for 2 or maybe 3 days. When removing the mask for later use, remember not to touch the outer, potentially contaminated surface of the mask. Hold it by the straps and keep it in a clean zip lock bag. If surgical masks are not available, studies have shown that even reusable / washable cloth masks can be better than no mask at all.
Impact On Future Ship Designs
As the world population continue to grow and our insatiable demand for resources drive us towards large scale exploitation of nature, human exposure to wild animals will increase exponentially and with it the number of zoonotic diseases. A zoonosis is an infectious disease caused by a pathogen that has jumped from its usual animal host to humans. Some recent examples include Marburg Haemorrhagic Fever ( 1967 W. Germany ), Ebola virus disease ( 1976 Sudan, Congo), Hanta virus pulmonary syndrome ( 1993 Four Corners, US ), H5N1 Avian Influenza ( 1997 Hong Kong ), Nipah virus disease ( 1998 Malaysia ), SARS ( 2002 Hong Kong ), MERS ( 2012 Middle East ) and COVID-19. These emerging infectious diseases frequently cause severe symptoms and carry with them high mortality rates.
To cater for these ever frequent disruptive epidemics, naval architects should design future warships with special considerations for disease prevention and treatment. Living quarters and work spaces could be bigger. Hot bunking should be a thing of the past. Every sailor should have his or her own room, even if it means it has to be capsule hotel style, small and cramped. The current bunking arrangement of segregation by rank, that is, Officer's mess, Petty Officer and Chief Petty Officer's mess, Junior Rank's mess, should be reviewed. It involves too much movement and intermingling of ship personnel. Instead ship crew should be divided into watch keeping teams and personnel from the same team bunk together, regardless of rank. So a ship can have several such sleeping quarters for different watch keeping teams and each should have its own heads, shower, laundry facilities, mini pantry, recreation area and maybe even a mini gym.
The ship should have dedicated rooms for medical treatment and isolation in case of a disease outbreak onboard the ship. Each isolation room should have its own toilet and sink so that the crew member in isolation need not get out of the room to wash or relieve himself. This requirement can be tough to meet on a small platform like Singapore's Victory-class missile corvette which is 62m long and has a displacement of 595 tonnes, but nobody says you should build designs like these anymore.
The future ship should also have advanced communications links between different compartments to transmit real time video and audio signals to reduce the need for the ship crew to physically gather for meetings and briefings.
The ultimate goal could perhaps be to eliminate the human crew altogether. If we can have a frigate-sized unmanned surface vessel that is remotely controlled and unmanned droid-carrying amphibious assault ships, we will not have to worry about diseases and outbreaks. In the event of war, there will be no casualties to worry about either! A Little far fetched but this day may arrive sooner than we think.
And lastly, for our readers whose town or city might be in lock down due to the COVID-19 pandemic, a gentle reminder to STAY HOME and help flatten the epidemiological curve in your country.
